Despite rising patient demand and commitments to strengthen primary care, one in three GPs with a license to practice in England are not working in NHS general practice, finds a study published by The BMJ.

The results also suggest that many newly qualified GPs are not entering the NHS general practice workforce or are leaving within the first 10 years.

Overall, the number of patients for each full-time equivalent GP in NHS general practice in England has risen by 15% since 2015. And by the end of 2024, there were twice as many NHS patients for each full-time equivalent NHS general practice GP than for each full-time equivalent NHS consultant.

The researchers say the findings highlight a widening imbalance between primary and secondary medical workforce capacity and a critical need to address the underlying reasons for workforce attrition in NHS general practice to achieve the government’s stated goals of strengthening community-based care.

Problems with recruitment and retention of GPs in England are longstanding, with many GPs citing unsustainable workloads, increasing demands from patients, and insufficient time to do justice to the job as reasons to leave or reduce their hours.

To better understand this shortfall, researchers set out to compare the numbers and characteristics of GPs across three national sources of workforce data, and to examine trends in GP numbers relative to population growth and the specialist medical workforce in England.

They found that, on average, for every five additional GPs licensed by the General Medical Council (GMC), NHS general practice lost one full-time equivalent GP each year for the period 2015–24.

As a result, the proportion of licensed GPs not working in NHS general practice increased from 27% (13,492) in 2015 to 34% (19,922) in 2024 by headcount and from 41% (20,210) to 52% (30,351) by full-time equivalent GPs.

The differences were greatest among female GPs, younger GPs, UK qualified GPs in absolute terms but GPs who qualified outside the UK in relative terms, and for GPs in London and the South East.

In contrast, between 2015 and 2024, for every five additional GMC licensed specialist doctors, the NHS gained 4.3 full-time equivalent consultants.

Taking population growth into account, the number of NHS patients for each full-time equivalent GP in NHS general practice increased by 15%, whereas the number of patients for each full-time equivalent NHS consultant fell by 18%. By the end of 2024, there were twice as many NHS patients for each full-time equivalent GP in NHS general practice (2,260) than for each full-time equivalent NHS consultant (1,092).

These are observational findings, so no firm conclusions can be drawn about cause and effect, and the authors acknowledge that discrepancies between data sources and poor recording methods likely underestimate GPs’ true working hours in NHS general practice.

However, they conclude, “Addressing the underlying reasons for workforce attrition in NHS general practice is critical to achieving the government’s stated goals of strengthening community-based care and shifting the focus of care from treatment to prevention.”

These trends threaten government plans to create a neighborhood health service, bringing care out of hospitals and into communities, underpinned by a revitalized general practice, say researchers in an associated editorial.

The editorial points out that after years of decline, the number of full-time equivalent fully qualified GPs has been rising since January 2025, offering hope that the tide may be turning, but highlights that ensuring jobs exist for newly trained GPs is only part of the solution.

“The complex mix of factors driving one in three qualified GPs out of NHS general practice must be addressed in the round,” the editorial argues. “The UK government has promised a long-term workforce plan in the autumn, and this research article describes a problem that plan must solve.”